الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Abetter understanding of tumor subtypes and molecular mechanisms of breast cancer is essential for development of innovative therapeutic strategies for modulation of the immune response.
The analysis of neoadjuvant treatment of breast cancer allows direct assessment of therapy response as well as its effect on disease-free survival and overall survival.
Tumor-infiltrating lymphocytes have been associated with higher rates of pathological complete response (pCR) to neoadjuvant therapy with improved prognosis in early and advanced stage TNBC and HER2-positive breast cancer.
The international immuno-oncology working group guidelines state that TILs should be assessed as a continuous variable to enable it to be implemented in algorithms encompassing other prognostic clinical-pathological variables.
While LPBC (60%) value was used commonly in most studies, present recommendations currently do not propose a specified cutoff for neoadjuvant patients.
In our study we confirmed that high TIL correlated with pCR after neoadjuvant chemotherapy, also patients with high TIL had higher DFS regardless pCR. Small tumor residual also improve the DFS if compared with larger residual.Also there is significant correlation between TIL level and molecular subtypes. HER2 positive patients have higher TIL level while luminal A subtype had no patients with high TIL level, estrogen receptor negative tumor are more immunogenic than ER positive tumor.
In the current trial there was no correlation between TIL level and improvement overall survival. Also there was no correlation with some clinical-pathological variables (tumor size, lymph node positive, tumor grade, KI67, type of surgery or menopausal status).
TIL may open multiple questions regarding the best regimen and sequence of NAC in locally advanced breast cancer. For example,
Can we omit taxenes in patients achieved pCR after 4 cycles of anthracyclines only?
Can we give taxenes/ trastuzumab only in HER2 positive patients with high TIL level?
Is there a group of patient that may benefit from adjuvant chemotherapy after NAC based on TIL level in residual tumor?